PAN Africa, PAN Germany, PAN North America
in cooperation with ICIPE, KEMRI
Framework for strengthening
Integrated Vector Management
in malaria control programmes
October 2013
A healthy world for all.
Protect humanity and the environment from pesticides. Promote alternatives.
Table of Contents
3
.........................................
About this document
4
.........................................
Integrated Vector Management: Safe and sustainable
7
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Step 1: Pre-planning
9
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Step 2: Planning
14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . an IVM Programme
Framework 1: Questions for situational analysis
vector management projects
Framework 2: Steps for funding on malaria vector control
in the context of IVM
17
.........................................
Annex 1:Vector control methods and their relative risks
18
.........................................
Annex 2:Pesticides recommended for malaria control: Concerns
18
.........................................
Annex 3:Recommended reading
19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References
Impressum
© Pestizid Aktions-Netzwerk (PAN) e. V.
Nernstweg 32, 22765 Hamburg, Phone +49 (0)40-3991910-0
[email protected], www.pan-germany.org
PAN Germany is a charitable organisation which provides information
on the adverse effects of pesticides and promotes environmentally
friendly and socially just alternatives. We are part of the Pesticide Action
Network International. Our work areas range from critical assessments
of the pesticide industry to constructive interaction with policy-makers to
practical services for farmers and consumers.
Hamburg, October 2013
Layout: grafik:sommer; printed on recycled paper
Photos: cover + p.12/ © PAN Africa; cover + p.7/ © Carina Weber;
cover + p.14/ © Laboratory of Vector and parasite ecology, Univ. Cheikh
Anta Diop, Dakar; p.5/ © North Dafur, Eva-Lotta Jansson/Oxfam;
p.8/ © Carina Weber; p.16/ © PAN Africa
This project was supported by:
This framework
was written by Carina Weber (PAN Germany), Dr. Charles Mbogo
(International Center for Insect Physiology and Ecology, ICIPE / Kenya
Medical Research Institute, KEMRI and Dr. Medha Chandra (PAN North
America)
We thank
Barbara Dinham (Independent Research Professional), Stefanie Keller
(Biovision Foundation for Ecological Development) and Dr. Henk van
den Berg (Wageningen University, Laboratory of Entomology) for valuable feedback and input.
Contact
Responsibility for the content of this publication lies with the authors.
The supporting institutions accept no responsibility for the correctness,
accuracy or completeness of the information, or for the observance of
the private rights of third parties. The views and opinions expressed
herein do not necessarily reflect those of the supporting institutions.
Acknowledgements: We thank our funders for their support.
2
Pestizid Aktions-Netzwerk e.V. (PAN Germany)
•
•
•
•
Carina Weber, Pesticide Action Network – Germany
[email protected]
Dr. Charles Mbogo, KEMRI/ICIPE
[email protected]
Dr. Medha Chandra, Pesticide Action Network – North America
[email protected]
Dr. Abou Thiam, Pesticide Action Network Africa
[email protected]
About this document
This document presents a decision making framework to assist malaria control
programme funders achieve a significant reduction in malaria morbidity and mortality through cost-effective, ecologically sound and sustainable Integrated Vector
Management (IVM) interventions. Community- and ecosystem-based IVM provide
effective vector control and minimize risks to human health and the environment.
This framework aims to strengthen these aspects of IVM in malaria control programs.
This ‘holistic’ IVM will reduce individual, community and environmental exposure to
pesticide hazards and risks. It will support the Stockholm Convention goal to reduce
reliance on, and ultimately eliminate use of, the persistent organic pollutant DDT.
The framework is a tool to assess whether new and on-going malaria project applications incorporate least toxic, effective and participatory disease control measures.
It will assist donors to collaborate with malaria programme applicants or managers
to incorporate robust pre-planning and planning phases that gather the information
and collate the data essential for evidence-based control strategies. The framework
can be used by officials who plan, design, fundraise for, implement or monitor a
programme to combat malaria and other vector-borne diseases to assess whether
they have adequately addressed key elements of IVM.
The framework focuses particularly on three key elements of a holistic IVM strategy:
a) evidence-based decision making at community level by community members
b) social mobilization to support communities becoming primary stakeholders in IVM
c) use of non-chemical approaches to vector control within community-guided IVM
These IVM strategies are additional to, and compatible with, the use of bed nets
and medicinal therapies.
The framework presents questions that funders can request applicants to
respond to. When successful applicants for malaria funding address the points
covered in these questions, the initiatives will incorporate elements of holistic IVM.
The framework provides indicators for malaria control programme officials to assess
whether IVM is adopted in their projects and programmes.
This document is based on literature from disease control programme planning
and incorporates lessons from on-the-ground activities that adopt sustainable IVMbased controls. It draws on WHO work and publications, in particular: the IVM handbook (WHO 2012a); Guidance on Policy-making for IVM (WHO 2012b) and Malaria
Indicator Survey (WHO 2012c). It took inspiration from the International Centre for
Insect Physiology and Ecology (ICIPE) implementation of IVM strategies that target
malaria in Africa (ICIPE 2012). And it draws on effective experiences in Mexico,
Kenya, Ethiopia and Senegal (PAN Germany 2010, ICIPE 2012, PAN Africa & PAN
Germany 2013). Many excellent technical IVM manuals and guides are available
and key references are listed in Annex 3.
This is a living document developed with experts of diverse experience and backgrounds. Feedback from those involved in financing or implementing malaria programmes will inform a next version. We invite all readers to give feedback.
Pestizid Aktions-Netzwerk e.V. (PAN Germany)
3
Integrated Vector Management:
Safe and sustainable
Box 1 WHO definitions and advice
on IVM
IVM is a rational decision-making process
to optimize the use of resources for vector
control … It is based on evidence and integrated management, promoting the use of
a range of interventions – alone or in combination – selected on the basis of local
knowledge about the vectors, diseases and
disease determinants. The IVM approach
addresses several diseases concurrently,
because some vectors can transmit several
diseases and some interventions are effective against several vectors. IVM will reduce the pressure imposed by insecticides
to select for insecticide resistance … IVM
encourages effective collaboration within
the health sector and with other public
sectors, and the empowerment of communities. (WHO 2012a)
The primary stakeholders in IVM are the
communities that will benefit from improved
vector-borne disease control. (WHO 2012a)
Understanding the basics about the locallyprevailing vectors of human disease is a
prerequisite to people’s involvement in
vector control, personal protection or vector
surveillance. Four aspects are considered
of key importance for those involved in an
IVM strategy: to identify vectors, understand their life cycle, to explore vector breeding sites, and to understand the role of the
vector in transmitting disease. (WHO 2010)
Vector control is often not sufficiently adapted to local or changing circumstances
because many countries lack capacity in
decision-making for vector control. Such
decisions should be based on evidence
about the characteristics of local vectors
and human behaviour and on the effectiveness of vector control methods. Furthermore, aspects of global change, such as
climate change, environmental degradation, water scarcity and urbanization, are
affecting the distribution of vector-borne
diseases. Vector control must be adapted
locally to these diverse and changing conditions and also to community preferences
and needs. (WHO 2012 b)
4
IVM is globally acknowledged as an important decision-making process to manage
disease vectors and reduce reliance on chemical controls. A sustainable, long-term
IVM approach will, at the same time, improve living conditions in vast stretches of
malaria endemic areas.
Effective implementation of IVM takes a holistic approach. It adopts ecological strategies for vector control that benefit the environment. And it works with local communities through existing social structures to deliver the information, training and support
necessary for them to effectively participate in malaria prevention programmes. A
good IVM project will be integrated within the national and local health systems and
with a national malaria control programme. IVM strategies are promoted in addition
to, and are compatible with, the use of bed nets and artemisinin-based combination
therapies (ACTs).
The World Health Organisation (WHO) promotes IVM for many reasons, for example
it is a rational, evidence-based decision-making process, it optimizes resources
for vector control, and it ensures communities benefit from improved vector-borne
disease control. Furthermore, IVM can help phase out the use of DDT for Indoor
Residual Spraying (IRS), supporting government commitments under the Stockholm
Convention to eliminate this persistent organic pollutant. In June 2013 governments
agreed to promote IVM as a tool for reducing pesticide hazards by adopting the
International Code of Conduct on Pesticide Management. The quotes in Box 1 from
WHO documents explain some reasons for adopting IVM.
Table 1 Key elements of Integrated Vector Management
Element
Description
1
Advocacy, social mobilization
and legislation
Promotion and embedding of IVM principles in designing policies in all relevant agencies, organizations and civil society;
establishment of strengthening of regulatory and legislative
controls for public health; empowerment of communities.
2
Collaboration within the health
sector and with other sectors
Consideration of all options for collaboration within and between public and private sectors; application of the principles
of subsidiarity in planning and decision-making; strengthening
channels of communication among policy-makers, vectorborne disease programme managers and other IVM partners.
3
Integrated approach
Ensuring rational use of available resources by addressing
several diseases, integrating non-chemical and chemical
vector control methods and integrating with other disease
control methods.
4
Evidence-based decisionmaking
Adaptation of strategies and interventions to local ecology,
epidemiology and resources, guided by operational research
and subject to routine monitoring and evaluation.
5
Capacity-building
Provision of the essential material infrastructure, financial
resources and human resources at national and local level to
manage IVM strategies on the basis of a situational analysis.
Source: WHO (2012a): Handbook for Integrated Vector Management
Pestizid Aktions-Netzwerk e.V. (PAN Germany)
The human elements of IVM are often overlooked. People living in high-risk malaria
areas must understand the basic causes of this and other vector-borne diseases and
how to protect themselves against locally-prevailing vectors. Sadly this is rarely the
case. A holistic IVM programme will ensure local communities have the knowledge
and support to establish and manage prevention activities. Their involvement is a key
to truly effective implementation. This aspect is stressed in the WHO key elements
of IVM strategies listed in Table 1.
An evaluation of IVM projects in Kenya and Ethiopia found that these have been:
“highly effective in reducing the threat of malaria by reducing mosquito densities using
eco-friendly means … The projects have had high value for money and are highly
scalable and sustainable” (ICIPE 2012). A review of 40 studies that emphasised
environmental management interventions concluded these are “highly effective in
reducing morbidity and mortality” (Keiser et al. 2005).
A global concern with the current approaches to malaria reduction is the problem
of resistance to the pesticides used against mosquitoes (and their larvae) in IRS
and in situ and the resistance of the parasite to ACTs (see Box 2). Pesticide use is
problematic too because of risks to health and the environment from poor chemicals management. When used, it should be guaranteed that pesticide handling is
in accordance with WHO standards.
Box 2 Resistance
Resistance to insecticides is an increasing
problem in vector control because of the
reliance on chemical control and expanding
operations, particularly for malaria and
dengue control. Furthermore, the chemical
insecticides used can have adverse effects
on health and the environment. (WHO 2012b)
… the threat of insecticide resistance
appears to be growing rapidly. Currently,
we are highly dependent on the pyrethroids,
as they are the only class of insecticides
used on insecticide-treated mosquito nets.
Resistance to pyrethroids has now been
identified in a wide variety of settings,
many of those in the most highly malariaendemic countries in Africa.” (WHO 2011)
Road construction is not just
good for economic development but is also a tactic
against malaria – as it
reduces puddles and pooled
water as potential mosquito
breeding sites on uneven dirt
tracks and unpaved roads.
Pestizid Aktions-Netzwerk e.V. (PAN Germany)
5
IVM and related environmental management techniques are unlikely to eradicate
malaria alone – but neither will long-lasting insecticide treated nets (LLITN), IRS
or ACTs (or current pesticide spray regimes). Integrated approaches which take
both local ecological conditions and social mobilization into account have proven
successful (PAN Germany 2010), and will, for example:
► address problems of resistance to the pesticides currently used for IRS and
potential problems with resistance to pesticides incorporated in LLITNs
► reverse the current trends that have seen a rise in pesticide use for malaria
control (WHO 2011a)
► support
government commitments under the Stockholm Convention to reduce
reliance on DDT for IRS, and ultimately to eliminate its use for disease vector control
► address the health concerns related to use of DDT in many malaria programmes
(urogenital malformations in new-born boys, impaired semen, cancers [see Annex 3])
► reduce
dependence on highly hazardous pesticides in developing countries
► break transmission rates from vectors that cannot be controlled by LLITNs or IRS,
notably Plasmodium falciparum in intensely endemic areas of Africa (Ferguson et. al.
2010 ; Reddy et al. 2011)
► reduce the exposure hazards that arise from poor pesticide management and
procurement, gaps in monitoring worker exposure or lack of pesticide awareness
► engage communities to deploy interventions based on knowledge of the origins
of malaria and evidence-based prevention strategies to reduce vector populations
► be cost-effective and sustainable, and thus vital when international funding for
malaria control is falling from its peak of US$ 2 billion in 2011 (World Malaria Report 2011)
Donors play an important role in promoting IVM by assessing the extent to which
applicants have considered and investigated its adoption. An effective project will
demonstrate that it has gathered data and carried out appropriate planning in two steps:
Step 1: Pre-planning to gather data for a complete assessment of the disease
situation (situation analysis)
Step 2: Planning the IVM programme design based on information obtained
The frameworks provided here guide donors to assess whether these steps have
been addressed, assist malaria funding applicants to incorporate IVM strategies,
and indicate how to approach planning IVM programmes and projects.
6
Pestizid Aktions-Netzwerk e.V. (PAN Germany)
Step 1
Pre-planning an IVM Programme
Currently, few malaria reduction projects or programmes incorporate holistic
IVM. Donors can play a vital role in guiding ecosystem-based, communitydriven strategies, based on:
A ► evidence-based decision making at community level by community members
B ► social mobilization to support communities becoming primary stakeholders in IVM
C ► increased use of non-chemical approaches within a community-guided IVM
The first step in an IVM programme is pre-planning to gather information and data for
an evidence-based strategy that is appropriate for the local communities, ecology,
disease profile and infrastructure (often termed a situational analysis). Applicants
should demonstrate they have gathered this information and considered how to
incorporate it in an IVM strategy.
As an IVM approach will not be familiar to all projects and programmes, donors
may consider separately funding this pre-planning step. Donors may consider this
step onerous; but when pesticides are part of a malaria control programme, donor
face obligations to ensure applicants can guarantee that: sound pesticide management and procurement practices operate; pesticide handling meets WHO standards;
communities will not be adversely affected by spray regimes or LLITNs; the project
is sustainable over time; and resistance assessment and monitoring strategies are
clearly in place.
Water is an essential basis
of life – for humans and the
environment, as well as
vectors transmitting diseases
such as malaria. Local
communities, including
farmers, need information on
managing water resources
to prevent mosquito breeding
sites.
Pestizid Aktions-Netzwerk e.V. (PAN Germany)
7
The guide for a situational analysis in Table 2 suggests content for pre-planning and
provides indicators to establish that information has been gathered. In summary,
it covers:
1.► Availability of a Malaria Indicator Survey (MIS) for the project country
2.► Local determinants of malaria: epidemiological and vector related data
3.► Demographic data and determinants of disease such as: living conditions,
proximity to mosquitoes, population movements, access to health care, knowledge
of malaria among communities and health workers
4.► Environmental determinants of disease, such as: climate, land-use, water
bodies, vector breeding habits
5.► Political, economic environmental, social and technological factors (PEEST
analysis)
6.► Information gaps
These questions should be applied initially to assess the project for its IVM strategy
and can be returned to throughout the project to adjust interventions to changing
conditions.
Children are curious – if
school systems support it,
they can easily learn about
vectors and their ecosystems
and can become important
stakeholders of programmes
to reduce malaria and other
vector born diseases.
8
Pestizid Aktions-Netzwerk e.V. (PAN Germany)
Framework 1
Questions for situational analysis
Table 2
Content of a situational analysis to inform IVM development in malaria projects and programmes
Question
Indicator
1.
Is a Malaria Indicator Survey (MIS) available for the MIS title and year of publication mentioned if
project country?
available.
2
Describe the local determinants of the disease by Note that a National MIS might provide information
providing the following data:
to answer the following questions.
2.1
Epidemiological data
2.1.1
What are the malaria prevalence and incidence rates in Data present and source of data identified.
the project area?
2.1.2
What are the number / kind of repeated episodes of Data present and source of data identified if this is availmalaria per household?
able from a separate project. Efforts should be made to
have this as part of the project baseline data.
2.1.3
What are the number / kind of repeated episodes per Data present and source of data identified if this is availperson?
able from a separate project. Efforts should be made to
have this as part of the project baseline data.
2.1.4
What are the entomological human biting rates / inocu- To be seen as supplementary information. If this could
lation rates?
be made available it could indicate important evidence.
2.1.5
What is the status of other vector-borne diseases prevalent in the project area that will be reduced by project
interventions along with malaria (e.g. Japanese encephalitis, leishmaniasis, dengue, lymphatic filariasis,
schistosomiasis or chagas disease)?
Which proactive efforts will be made for optimal planning to maximize impact on malaria and other prevalent
vector borne diseases?
2.1.6
What is the disease stratification? Does the country have Maps present and source of data identified.
up to date information on different malaria levels in different areas – high, moderate, low or none?
Vector related data
2.2
2.2.1
Other vector borne illnesses identified and disease
statistics over time obtained for those that can be tackled
using malaria control strategies.
Proactive efforts described.
What are the main vectors in the project area?
Data present and source of data identified.
Which Plasmodium species are prevalent?
What is the status of insecticide resistance in vectors?
What is the status of drug resistance in parasites?
2.2.1.1 What is the seasonality of their occurrence? What are Data gathered from interviews with community and local
the local densities and fluctuations of the vectors? Are malaria control officials.
dry season refuge areas known?
2.2.1.2 Is their biting and resting occurring mainly indoors or This information is often not available. Possibly local
outdoors; or is this unknown? Does biting occur (partly) malaria control officials can provide data on these quesin the early evening before people sleep or exclusively tions.
at night; or is this unknown?
2.2.2
Are the results of recent insecticide susceptibility tests (WHO Data present and source of data identified
bioassay) available, and if so, do they indicate reduced susceptibility to pyrethroids and/or other insecticide classes?
Pestizid Aktions-Netzwerk e.V. (PAN Germany)
9
3
Demographic data, determinants of disease: human Note that a National MIS might provide information to
answer the following questions.
related factors
3.1
What is the profile of malaria cases in the community? Statistical data collected on gender, age, education level,
economic status, travel history, geography of malaria
What is the larger community statistical description?
sufferers and overall community members.
3.2
Has a community-based physical mapping of the local
population and disease characteristics been incorporated in the project?
Who are the local stakeholders that should be involved
in that mapping exercise?
Local stakeholders of various sectors identified; leadership of community based physical mapping exercise
identified from within the community; this exercise conducted and maps created.
3.3
Where do vulnerable human groups live in relation to
vector hot spots?
What human behaviours are relevant to vector biting
habits: for example adult and children sleeping patterns;
use of bed nets.
Do vectors bite early evening or later when most people
are in bed?
Mapping completed of homes with children under age
5, with women of childbearing age, and mapping of significant vector breeding grounds is available.
behaviours such as time of sleeping, use of bed nets
and time of vector biting patterns documented and correlated.
3.4
Which human populations live close (<500m) to major Populations identified; numbers assessed.
vector breeding grounds (e.g. perennial water bodies
or swamps)?
3.5
What are the patterns of population movement?
3.6
Which meetings where people congregate in large num- Community meetings that could be strategic to implebers at the community level could be used strategically ment a community based IVM approach are detailed.
to support the implementation of a community-based
IVM approach? How often/where do these meetings
take place?
3.7
What is the nature and quality of community access to Listing of medical facilities, community health workers
diagnostic and treatment services
and other health care services, both government and
(including community-based treatment)?
non-government. Include such relevant data as: distance
from settlement for each health facility; frequency of visits to these facilities; number and per cent of cases
treated at facilities related to total cases in the target
community. This information may require active surveillance as usually only cases reported at clinics are known.
3.8
How accurate is diagnosis (rapid diagnostic testing and Effectiveness of malaria treatment medicines measurmicroscopy) and how effective is the medication they able through a community survey (number of days from
start of medication to recover fully from symptoms of
receive (if known)?
current infection; this information correlated with drug
efficacy data from standard pharmacology texts).
Effectiveness of preventative medicines (numbers contracting malaria while taking preventative medicines)
– measurable through survey of medical personnel or
community health workers.
10
Pestizid Aktions-Netzwerk e.V. (PAN Germany)
Patterns of population movement in the community mapped
with special emphasis on activities that can cause increased human-vector contact (e.g. working outdoors at
dawn or dusk in areas where the vector has an outdoor
biting characteristic at these times).
3.9
Has the staff in health centres been trained on non- Information is made available.
chemical approaches to IVM?
Do health centres give advice on non-chemical
approaches to reduce transmission?
3.10
What activities and actions do communities currently
undertake to prevent and control malaria?
How are these activities linked with the national malaria programme and activities of stakeholder groups like
farmers, women, environment and health organizations
or schools etc.?
Is the kind and extent of community activities and actions
different in different seasons?
Identified which vector management methods listed in
Annex 1 of this framework are used and whether activities vary in different seasons.
4
Environmental determinants of disease
Note that a National MIS might provide information to
answer the following questions.
4.1
What is the relevant meteorological data?
Climate data (confounding data); rainfall data; temperature data provided.
Note: Information might be available on the basis of the
implementation of the WHO guide Monitoring & Evaluation – Indicators for IVM (WHO 2012d)
4.2
What is the local land use (including nomadic land use)? Local land use mapped.
4.3
What are the local ecosystems?
What is the seasonal pattern of local water use and
spatial distribution of local water? Which ecosystems
are mostly associated with malaria transmission (e.g.
rural-agricultural; urban; riverine; coastal etc.)?
Local water bodies and community water use points
mapped.
4.4
What are the breeding habitats and sites?
Local breeding grounds identified, mapped and enumerated with community input.
5
PEEST analysis
(Political, Economic, Environmental, Social,
Technological factors that affect malaria control
efforts at various levels)
Note that a National MIS might provide information to
answer the following questions.
Note: Information might be available on the basis of the
implementation of the WHO guide Monitoring & Evaluation – Indicators for IVM (WHO 2012d)
5.1
Policy environment
Policies listed from all sectors of government that are
What policies of government, regional administration involved – such as health, agriculture, environment –
or local government have direct or indirect impact on and from different levels of government.
the project?
Is IVM a national policy?
Does the government give priority to training and human
resources development on IVM?
5.1.1
Will the proposed malaria control programme be static Malaria control programme has built in stages in its process
rather than adaptive to local situations and changes over for reviewing local situation and responsive plan adaptatime?
tion; involvement of cross-departmental and cross-sectorial
stakeholders in reporting on local situation and responding
to it through regular meetings and plan updating.
5.1.2
What are the policies explicitly encouraging IVM in public Policies noted and effectiveness assessed.
health and/or IPM in agriculture?
5.1.3
Are any policies a barrier to implementation of least to- Policies noted and gaps / shortcomings assessed. Stratexic, community-based IVM?
gies to address barriers noted or considered.
What are the gaps / shortcomings of inconsistencies in
the policy framework that affects the project?
5.1.4
What policy instruments – including legislation, regula- Policy instruments noted and implementation strategies
tions or programmes – are in place for operationalizing assessed.
the beneficial policies?
Pestizid Aktions-Netzwerk e.V. (PAN Germany)
11
5.1.5
What are the budget allocations for least toxic, non- Budget allocations identified (if exists); potential budget
chemical, community centred approaches?
sources identified; potential ‘champions’ for community
IVM identified.
5.1.6
Are approaches in place that aim for control of more Approaches such as joint planning of interventions betthan one vector-borne disease?
ween two disease-specific programmes; or the sharing
of expertise or equipment / transport between diseasespecific programmes listed.
5.1.7
Will a health and environmental impact assessment be
conducted as part of the project to assess the impact of
existing programmes in other sectors on malaria risk?
Institutional arrangements and capacities
What institutional arrangements are in place for operationalizing the policy instruments?
What capacities / human resources are available for
planning, implementation, evaluation?
5.2
Budget allocation for impact assessment included.
Institutional arrangements in place for operationalizing
the policy instruments listed.
Capacities / human resources available for planning,
implementation, evaluation identified.
Note: Information might be available on the basis of the
implementation of the WHO guide Monitoring & Evaluation
– Indicators for IVM (WHO 2012d).
5.2.1
Is there an IVM focal point with financial and operational Details of focal point supplied; powers assessed.
powers over the malaria control project?
5.2.2
Will stakeholders from all levels and sectors be involved
in the planning, implementation and evaluation of the
project?
Are local leaders and NGOs closely involved in malaria
control?
Are IVM training materials available for communities?
5.3
Political environment
5.3.1
What are the political agendas of various stakeholder Assessment presented.
groups with respect to malaria control in the community?
In what way do these different political agendas align or
oppose each other?
What are the political driving forces that stimulate or
hinder the implementation of non-chemical approaches
and community participation?
Who is interested in community based IVM and what
are their experiences?
Who is opposing it? Who has clear ideas?
5.3.2
Are there already organisations / individuals with a man- Assessment conducted; contacts made with relevant
date to support / coordinate community action and im- organisations and individuals.
plement non-chemical approaches to prevent malaria?
6
Information gaps
6.1
What information is / was not available and what gaps Overview presented by listing the questions.
need to be covered by the project?
12
Pestizid Aktions-Netzwerk e.V. (PAN Germany)
Stakeholders enumerated and interviewed from appropriate categories – government, non-governmental organisations, community, agriculture, medical, environment,
research or cross-departmental. Views / vision of each
stakeholder described for malaria control. Note – what
kind of malaria control practices do they condone, are
aware of and accept; and what do they oppose or are
unaware of.
Clear roles identified for different stakeholders and
processes established for regular consultations and
meetings; clear processes developed for stakeholder
involvement in and responsibility for implementation,
evaluation and monitoring of programme.
Step 2
Planning vector management
projects
The emphasis of the applicant should be on considering and integrating environmental, mechanical and biological vector control methods into their project
or programme. Planning will assist country strategies to reduce reliance on DDT.
Annex 1 lists the range of interventions available. It shows options for integrating methods into malaria programmes and projects and it supports planning of communitydriven vector management.
IVM which stresses localized solutions and evidence-based decision-making is one
of the most promising vector management approaches. The concept stresses local
environmental management, personal control measures, biological controls and
community empowerment. Social and behavioural factors play a key role in determining how people respond to the malaria threat. Policy makers and those developing
malaria projects must pay attention to these behavioural factors in deciding among
different malaria control strategies.
Projects and programmes should consider: epidemiological and entomological factors; resources for the programme (delivery systems); community engagement and
adherence; sociological and demographic factors’; and an assessment of other
factors that may negatively affect an IVM programme. Donors can help projects and
programmes become more robust in selecting the right vector control interventions
and strategies for community empowerment into holistic IVM. They may consider
providing seed funding to enable applicants to collect essential planning information
and control options.
The choosing of an appropriate vector control option should assess feasibility and
success. A critical tool for IVM is Larval Source Management (LSM) which will reduce
risks and maintain and/or increase success. Four main categories of vector control
methods can be effective (see Box 3) – environmental, mechanical, biological and
chemical. The operational manual “Larval Source Management: a supplementary
measure for malaria vector control“(WHO 2013) provides guidance on LSM.
Box 3 Larval Source Management (LSM)
LSM is the management of aquatic habitats
(water bodies) that are potential larval
habitats for mosquitoes in order to prevent
the completion of immature development.
There are four types of LSM:
1. Habitat modification: a permanent
alteration to the environment e.g. land
reclamation
2. Habitat manipulation: a recurrent
activity e.g. flushing of streams
3. Larviciding: the regular application of
biological or “chemical insecticides” to
water bodies
4. Biological control: the introduction of
natural enemies into water bodies
Source: Fillinger and Lindsay (2011)
Access to information and
good knowledge about malaria and other vector born
diseases are crucial as part
of a holistic multisector,
multistakeholder and ecosystem-based, communitydriven integrated vector
management approach. This
can help people to contribute
to the reduction of malaria
and the elimination of DDT.
Pestizid Aktions-Netzwerk e.V. (PAN Germany)
13
Framework 2
Steps for funding on malaria vector control in the
context of IVM
The following presents a step-by-step decision making framework to identify a
national context that will support IVM programmes and projects. This framework
can be used by:
A ► donors to government malaria programmes to support and integrate IVM strategies
A ► countries in developing an IVM programme, or when funding programmes and
projects within their country
A ► donors to non-governmental stakeholders, and these stakeholders as an orienta tion for their malaria programme or project planning
Box 4 Important entomological
information
What are major vector species identified
and which molecular forms are available?
Is the biting, feeding and resting behaviour
of the major vector species known?
Is it known that malaria vectors mainly but
not always feed indoors – What is the situation in your country?
What is the vector resistance status including resistance mechanisms and potential
for cross resistance?
Healthy housing – screens
on doors, on windows or to
close gaps between walls and
roofs of houses or huts can
be installed by families to reduce human-vector contacts.
The information gathered in Step 1 for pre-planning should enable this decisionmaking framework to be followed. It will help select and evaluate options for malaria
control interventions and allow an understanding of the risks of chemicals in comparison to non-chemical control approaches (Annex 1).
CRITERIA 1 Does the country have a national malaria control policy or strategic
plan that: promotes selective and targeted interventions within an IVM
program that encourages effective collaboration not only within the
health sector but also with other public sectors; empowers communities; and deploys non-chemical approaches, such as LSM, to vector
control?
No The policy/strategic plan should be revised to accommodate selection
of vector control interventions in the context of IVM.
Yes Move to Criterion 2
CRITERIA 2 Does the country have up-to-date information on different malaria levels
in different areas (high, moderate, low or none) with areas targeted
for various interventions (singly or in combination) well identified?
No
Update the information on different malaria levels and determine the
targeted areas:
Yes Move to criterion 3
CRITERIA 3 Does the country have up-to-date entomological information on the
malaria vectors from the targeted areas for vector interventions? This
is very important information and each country should provide a detailed analysis guided by the questions in Box 4. These details should
be available from the pre-planning step 1 information.
No
Collect the necessary information.
Yes Analyse the information and determine which vector intervention (nonchemical vs. chemical) is appropriate or not and move to criterion 4 if
chemical is preferred.
CRITERIA 4 The country has effective policies and regulations in place (including
national implementation plans for the Stockholm Convention (for countries that are parties to this Convention).
No
Establish the necessary policies and regulations.
Yes Move to criterion 5.
14
Pestizid Aktions-Netzwerk e.V. (PAN Germany)
CRITERIA 5 There are adequate resources and capacity such as human, financial,
information and infrastructure, to safely, effectively and judiciously
apply any of the selected vector control interventions. (See answers
to “5 PEEST analysis” in Step 1.)
No
Ensure that the required resources are in place (preferably for more
than one cycle). If the required information and/or resources are not in
place, malaria control programme funders should consider financing
a pre-project implementation phase to guarantee that a project can
start with the appropriate data bases and resources.
Yes Develop the operations plan and move to implementation following
the WHO IVM Manual.
WHO requests countries to adopt new malaria vector control strategies (WHO
2012a); IVM strategies are critical for countries that set a goal of ‘malaria elimination’.
To plan this, country epidemiological and entomological data are very important to
classify levels of malaria and guide selection of appropriate vector control strategies.
To sustainably reduce risks from malaria and from chemical interventions a project
or programme must decide which mosquito control method is appropriate and how it
will be used in a given context. This process must generate research and be guided
by a comprehensive analysis of the level of malaria endemicity, vector bionomics,
vector population dynamics, the eco-epidemiological setting, the health management
system, environmental and social factors and the ability to sustain the programme.
At country level, governments need regulatory measures to prevent the creation of
man-made vector breeding sites and to ensure proper vector management.
Risk of
resistance
Community
participation
Affordability
Source reduction
++
+
-
++
++
Habitat manipulation
±
+
-
±
±
Irrigation management & design
±
+
-
+
±
Mechanical
House improvement
++
++
-
++
+
Biological
Natural enemy conservation
±
+
+
+
+
Biological larvicides, e.g., Bti
++
+
+
+
-
Botanicals e.g., neem oil
+
±
+
+
+
Insecticide-treated bed nets
++
±
-
+
-
Indoor residual spraying
++
±
-
-
-
Insecticidal-treatment of habitats
±
-
-
-
-
Chemical repellents
±
±
+
+
±
Chemical
++ indicates: highly applicable; + applicable; ± partly applicable; - not applicable
Source: WHO 2012: Handbook on Integrated Vector Management–modified to fit current situation
Chemical
red
uce
Safely
Environmental
Biological
Integrated Vector Management
Environmental
uce
od
intr
Vector control method
ce
odu
intr
Category
Effectiveness
Table 3 Example of the use of selection criteria for vector control methods against malaria
Figure 1 Route map for selection of
vector measures
intr
odu
ce
Vector control methods can be divided into environmental, mechanical, biological and
chemical methods (see Annex 1). An appraisal of each method will assist in selecting
the most appropriate in the local context. The appraisal incorporates the aspects
of effectiveness, human and environmental safety, risk of resistance development,
affordability, and community participation. Table 3 summarises the requirements;
Figure 1 sets out a route map for the selection process.
Mechanical
Pestizid Aktions-Netzwerk e.V. (PAN Germany)
15
IRS and LLINs used for indoor protection will have limited utility against early or
outdoor biting. Examples of important vector control methods include:
• Biological control: Larvivorous fish may be recommended for control of Anopheles
in large water bodies or larger water containers not just but especially in urban
settings.
• Endotoxin-producing bacteria, Bacillus thuringiensis serotype H-14 (Bt H-14) has
been found an effective mosquito control agent and is now widely used.
• Involvement of household and community for mosquito control through the task
of eliminating mosquito breeding in and around their houses by filling and draining
of mosquito larval breeding.
Any sustainable malaria control program will need to strategically address a complex range of environmental and social determinants in a cost-effective manner. As
causal factors differ and change, control programmes need the flexibility to adjust
their strategies.
The selection of the IVM components should be based on a situational analysis,
as demonstrated in step 1. This helps to establish the: effectiveness and cost effectiveness of the methods, acceptance by communities, availability of resources,
environmental safety and feasibility. The aim is to develop a vector control strategy
and programme that includes the community and the methods that are adaptable
to the local situation and that can be sustained.
Important questions to be
answered before planning
activities: What are the
main vectors and what is
their biting and resting behavior?
16
Pestizid Aktions-Netzwerk e.V. (PAN Germany)
Annex 1
V e c t o r c o n t r o l m e t h o d s a n d t h e i r r e l a t i v e r i s k s
Risk A ► Low or no risk to human health or the environment – bioreliant / low pesticide reliant method
Risk B ► Moderate risk to human health or the environment – low pesticide reliant method
Risk C ► High risk to human health or the environment – pesticide reliant method
Risk D ► High risk to the environment or human health – should only be used as a very last resort
Vector control methods
Risk Level
1
Environmental management methods
1.1
Ecosystem compatible habitat modification (such as clearing of
stagnant water, breeding sites physically destroyed or modified,
removal of vegetation from near house etc.)
A
1.2
Habitat manipulation (irrigation management, removal of trash)
A
1.3
Other
2
Mechanical methods
2.1
House improvement, including screening of eaves
A
2.2
Improved sanitation
A
2.3
Use of long sleeved shirts
A
2.4
Bednets / untreated (avoid human-net contact!)
A
2.5
Mosquito screens
A
2.6
Mosquito traps and targets
A
2.7
Other
3
Biological methods
3.1
Botanical repellents (neem, citronella)
A
3.2
Ecosystem compatible predators (larvivorous fish) or nematodes
(under development)
A
3.3
Bacterial larvicides (Bt)
B
3.4
Botanical pesticides (pyrethrum)
B
3.5
Fungi (under development)
B
3.6
Other
4
Chemical methods
4.1
Bednets / treated with insecticides
B
4.2
Treated curtains or hammocks
B
4.3
Durable wall lining
B
4.4
Chemical repellents
B
4.5
Chemical larvicides
C
4.6
Sponging cattle with insecticides
C
4.7
Indoor residual spraying with insecticides
C
4.8
Space spraying of insecticides (areas of land)
4.9
Other
D
Pestizid Aktions-Netzwerk e.V. (PAN Germany)
17
Annex 2
Pesticides recommended for malaria control: Concerns
This list indicates human toxicity concerns associated with pesticides used in malaria control programmes.
There are also environmental concerns; nearly all pesticides in malaria programmes are toxic to the
important pollinators bees.
Bifenthrin (pyrethroid): Is a possible human carcinogen (Group C) according to US EPA • At least one
study provides evidence of endocrine disruption in an intact organism* according to EU • It is highly
bioaccumulative ** and very persistent in water/sediment ***
Deltamethrin (pyrethroid): At least one study provides evidence of endocrine disruption in an intact organism according to EU.
Bifenthrin (pyrethroid): Is a possible human carcinogen (Group C) according to US EPA • At least one
study provides evidence of endocrine disruption in an intact organism* according to EU • It is highly
bioaccumulative** and very persistent in water/sediment***
Deltamethrin (pyrethroid): At least one study provides evidence of endocrine disruption in an intact organism* according to EU.
DDT: At least one study provides evidence of endocrine disruption in an intact organism* according
to EU • According to US EPA it is a probable human carcinogen (Group B2) • According to IARC it is
a possibly carcinogenic to humans (Group 2B) • In the EU Directive 67/548 it is listed as a substance
which causes concern for humans owing to possible carcinogenic effects (Category 3) • It is covered by
the Stockholm Convention and by the Rotterdam convention. The following studies document concerns
with exposure to DDT:
• WHO (2011): DDT in indoor residual spraying: human health aspects. Environmental Health Criteria
241, World Health Organization
• Bornman R et al. (2009): DDT and urogenital malformations in new born boys in a malarial area.
BJU International Eskenazi, B et.al (2009): The Pine River Statement: Human Health Consequences
of DDT Use, Environ Health Perspect. 2009 September; 117(9): 1359–1367
• Aneck-Hahn, N.H. et al. (2007): ‚Impaired semen quality associated with environmental DDT exposure
in young men living in a malaria area in the Limpopo Province, South Africa‘, J. Androl., (28) 423–434
• Bouwman, H; Kylin, H (2009): Malaria control insecticide residues in breast milk: The need to consider
infant health risks. Environ. Health Perspect. (117) 1477–1480
• Cohn, B A et al. (2007): DDT and breast cancer in young women: new data on the significance of
age at exposure. Environ. Health Perspect. (115) 1406–1414
• de Jager, C. et al. (2006): Reduced seminal parameters associated with environmental DDT exposure
and p,p‘­DDE concentrations in men in Chiapas, Mexico: A cross-sectional study. J. Androl, (27) 16–27
• Ukropec, J (2010): High prevalence of prediabetes and diabetes in a population exposed to high
levels of an organochlorine cocktail. Diabetologia (53) 899–906
Fenitrothion: According to EU at least one study provides evidence of endocrine disruption in an intact
organism*.
Lambda-cyhalothrin (pyrethroid): According to EU at least one study provides evidence of endocrine disruption in an intact organism* • According to the EU Directive 67/548 it is very toxic by inhalation (R26).
Malathion (organophosphate): Highly toxic to bees • US EPA: Suggestive evidence of carcinogenicity
but not sufficient to assess human carcinogenic potential • EU: Potential for endocrine disruption (ED),
in vitro data indicating potential for endocrine disruption in intact organisms, also includes effects in vivo
that may or may not be ED-mediated, may include structural analyses and metabolic considerations.
Propoxur (carbamate): US EPA: Probable human carcinogen (Group B2).
Annex 3
Recommended reading
* Not a formal weight of evidence approach
** Highly bioaccumulative according to
REACH criteria as listed by FOOTPRINT
(BCF >5000)
***Very persistent” according to REACH
criteria as listed by FOOTPRINT (half-life
> 60 d in marine- or freshwater or half-life
> 180 d in marine or freshwater sediment)
18
Key readings
• Ferguson, H M et al. (2010): Ecology: a prerequisite for malaria elimination and eradication.
PloS Medicine 7: e1000303.
• ICIPE (2012): Report of the comprehensive external evaluation of the Biovision-ICIPE IVM projects
in Kenya and Ethiopia, International Centre of Insect Physiology and Ecology
• Keiser, J; Singer, B H; Utzinger J (2005): Reducing the burden of malaria in different eco epidemiological settings with environmental management: a systematic review. http://infection.the
lancet.com, Vol 5, November 2005
• PAN Germany & PAN Africa (2013): Combating malaria without DDT in Beer, Senegal – report on
a pilot project to raise awareness of the causes of malaria and initiate non-chemical methods and
activities for its prevention
• PAN Germany (2010): Environmental strategies to replace DDT and control malaria. 2nd extended
edition. Pesticide Action Network – Germany
• Roll Back Malaria Partnership / UNDP (2013): Multisectoral Action Framework for Malaria.
Pestizid Aktions-Netzwerk e.V. (PAN Germany)
•
•
•
•
•
•
UNEP (2011): Stockholm Convention on Persistent Organic Pollutants (POPs). Available at:
http://chm.pops.int/Convention/ConventionText/tabid/2232/Default.aspx
van den Berg, H et al. (2009): Global Status of DDT and its alternatives for use in vector control to
prevent diseases. Environmental Health Perspectives, Volume 117, No. 11
WHO (2010): Core Training curriculum on Integrated Vector Management. Commissioned by the
Neglected Tropical Disease Department. World Health Organization
WHO (2012): Guidance on policy-making for integrated vector management. By Henk van den
Berg, Clifford M. Mutero and Kazuyo Ichimori. World Health Organization
WHO (2012): Malaria Indicator Survey. World Health Organization. Available at:
http://www.rbmwho.int/toolbox/tool_MISToolkit.html
WHO (2013): Larval Source Management: A supplementary measure for malaria control – An
operational manual
Additional readings
• Beier, J et al. (2008). „Integrated vector management for malaria control.“ Malar J 7(Suppl 1): S4
• PAN International (2011): List of Highly Hazardous Pesticides. Available at:
• http://www.pan-germany.org/gbr/project_work/highly_hazardous_pesticides.html
• Ranson, H et al. (2011). „Pyrethroid resistance in African anopheline mosquitoes: what are the
implications for malaria control?“ Trends Parasitol 27: 91-98.
• Thomas M B et al. (2012). „Lessons from agriculture for the sustainable management of malaria
vectors.“ PloS Medicine 9(7): e1001262.
• Van den Berg, H et al. (2011): Status of pesticide management in the practice of vector control: a
global survey in countries at risk of malaria or other major vector-borne diseases. Malaria Journal
2011, 10:125, doi:10.1186/1475-2875-10-125. BioMed Central – The Open Access Publisher
• WHO (2012): Handbook for Integrated Vector Management. World Health Organization
• WHO (2012): Monitoring & evaluation - indicators for Integrated Vector Management. World Health
Organization
• WHO (2012): World Malaria Report, World Health Organization
• WHO (2011): World Malaria Report, World Health Organization
References
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Bouwman, H et al. (2006): Simultaneous presence of DDT and pyrethroid residues in human breast
milk from a malaria endemic area in South Africa. Environ Pollut 144:902–917
Ferguson, H M et al. (2010): Ecology: a prerequisite for malaria elimination and eradication.
PloS Medicine 7: e1000303.
Fillinger and Lindsay (2011). Larval source management for malaria control in Africa: myths and
reality; Malaria Journal, 10:353 doi:10.1186/1475-2875-10-353
ICIPE (2012): Report of the comprehensive external evaluation of the Biovision-ICIPE IVM projects
in Kenya and Ethiopia, International Centre of Insect Physiology and Ecology
PAN Africa / PAN Germany (2013): Combating Malaria without DDT in Beer, Senegal. Report on a
pilot project to raise awareness of the causes of malaria and initiate non-chemical methods and
activities for its prevention. Dakar, Hamburg
PAN Germany (2010): Environmental strategies to replace DDT and control malaria. 2nd extended
edition. Pesticide Action Network – Germany
Reddy, M R et al. (2011): Outdoor host seeking behaviour of Anopheles gambiae mosquitoes
following initiation of malaria vector control on Biolo Island, Equatorial Guinea. Malaria Journal 2011,
10:184
UNEP (2011): Stockholm Convention on Persistent Organic Pollutants (POPs). Available at:
http://chm.pops.int/Convention/ConventionText/tabid/2232/Default.aspx
WHO (2010): Core Training curriculum on Integrated Vector Management. Commissioned by the
Neglected Tropical Disease Department. World Health Organization
WHO (2011): World Malaria Report, World Health Organization
WHO (2011a): Public Health Pesticide Registration and Management Practices by WHO Member
States. Report of a Survey 2010. Control of Neglected Tropical Diseases. Pesticide Evaluation
Scheme. WHO/HTM/NTD/WHOPES/2010 Geneva. World Health Organization
WHO (2012): World Malaria Report, World Health Organization
WHO (2012a): Handbook for Integrated Vector Management. World Health Organization
WHO (2012b): Guidance on policy-making for integrated vector management. By Henk van den
Berg, Clifford M. Mutero and Kazuyo Ichimori. World Health Organization
WHO (2012c): Malaria Indicator Survey. World Health Organization. Available at:
http://www.rbm.who.int/toolbox/tool_MISToolkit.html
WHO (2012d): Monitoring & evaluation - indicators for Integrated Vector Management. World Health
Organization (available at: http://apps.who.int/iris/bitstream/10665/76504/1/9789241504027_eng.pdf)
WHO (2013): Larval Source Management: A supplementary measure for malaria control – An
operational manuat
Pestizid Aktions-Netzwerk e.V. (PAN Germany)
19
Pesticide Action Network (PAN)
is an international network of over 600 NGOs in over 90 countries. PAN aims to reduce exposure of the most vulnerable communities around the world to highly hazardous pesticides (HHPs), while advancing effective and least toxic
alternatives. Some HHPs are commonly used in malaria control activities.
ICIPE
is an international scientific research institute headquartered in Kenya. Objectives are to help ensure food security
and better health for humankind and its livestock; to protect the environment; and to conserve and make better use
of natural resources. ICIPE‘s mission is to help alleviate poverty, ensure food security and improve the overall health
status of peoples of the tropics by developing and extending management tools and strategies for harmful and useful
arthropods, while preserving the natural resource base through research and capacity building.
KEMRI
is a state corporation and the national body responsible for carrying out health research in Kenya. In its commitment
to meeting the health challenges KEMRI has consolidated its research activities into six main research programmes:
1. biotechnology, 2. traditional medicine and drug development, 3. infectious and parasitic diseases, 4. Public health
and health systems, non-communicable diseases, 6. Sexual, reproductive and child health.
A healthy world for all.
Protect humanity and the environment from pesticides. Promote alternatives.